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HomeMy Public PortalAboutSolomon Av_1405 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE 1 OMB No. 1660-0008 Federal Emergency Management Agency Expires February 28.2009 11 National Flood Insurance Program Important; Read the instructions on pages 1-8. SECTION A - PROPERTY INFORMATION 1 For Insurance Company Use: Al. But ciet same // C J � 0 I Policy Number A2. But leg Street Ad(i ss (including Apt. nit, Suite, and /or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 1 3 5 � IoytnOrr u z c4 77-4600a 1'6,, State ZIP Code 31348 A3 es ption (Lot an Block um Nbers, Tax Parcel 1 De ption, tc.) ti r - c�ozZ of - ?4- � d i Q �'�a �cj ,,yLJ Rg __ r Z - ��1 13 A4. Building Use (e.g., Residential, Non- Residential, Addition, Accessory, etc.) Rest `°$ 7 - IC I A5. Latitude/Longitude: Lat. Long. Horizontal Datum: ❑ NAD 1927 Q NAD 1983 A6. Attach at least 2 photograph f the building if the Certificate Is being used to obtain flood insurance. A7. Building Diagram Number b _a_C) A8. For a building with a crawl space or enclosure(s), provide: A9. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade ® wails within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b C) sq in c) Total net area of flood openings in A9.b sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1 .N NFI Commu ' Ntme Oommunity Number B2. Coun Nam B3. State 2; "lctr�d 64 /35 (Q 64. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone /3 5 /b 4 /m0 I C D EffeccGye/Rejfi Date * Zc b j ) AO, ufte asE, flood depth) B10. Indicate the source of the Base Flood Elevation ( FE) data or base flood depth entered in Item B9. 0 FIS Profile I t IRM ❑ Community Determined 0 Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes IT No Designation Date ❑ CBRS 0 OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* YFinished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a -g below according to the bu'Idi d agram specified in Item A7. Benchmark Utilized 4 .1 Vertical Datum + Conversion/Comments Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor) 9+ V 0 meters (Puerto Rico only) b) Top of the next higher floor /0 . _ feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) ----/ 6 t:_1 feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) / . n feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building /0 5 i ❑ meters (Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) i .0 1"ffeet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 9 (.1Lkfeet ❑ meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. "�` I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. 0 PROF- L'7 Check here if comments are provided on back of form. 0l, 1, � ) , Y . Certifiers Name p7 ¢ C ! ' L • II 1 -P b License � i ' ` G- S } CC oo , (/j yam` 4-41 Title ice' LQ11 a -'cit/'oa ame K� •/ 6 i l (, r�Ci? f i `"' IP Code 3 � � qu r � � �> ;° zo Address J,5 r:pn ( ��/ Q 1'. _ StatQs/,.,,,, :/ 8e c 11, si ( /�� 1 (' \ n r` 1��� i. _ / Date i k � Telep r ` � _ A �i�1C 1, �j -01 _en FEMA Form 81 -31, February 2006' See reverse side for continuation. Replaces all previous editions MPORTANT: In these spaces, copy the corresponding information from Section A. I For Insurance Company Use: 3UILDiNG RE T AD S (Including Apt., Number Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. � Policy Nber /4 ' 5 © IAati\ c� CITY _7 1 y ' STATE/ r / )� CODE Company NAIC Number l SECTION D - SURVEYOR, ENGiNEER, ` ARCHITECT CERTIFICATION (CONTINUED) 3opy both sides of this Elevation Certificate for community official, (2) insurance agent/campaiy, and (3) building owner. COMMENTS vet -' l' ( �3 ! /fed — , o viz u�t /bar. vi4c�c sL, Pl • I I Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) or Zone AO and Zone A (without BFE), complete Items El. through E5. If the Elevation Certificate is intended for use as supporting iformation for a LOMA or LOMR -F, Section C must be completed. 1. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) 2. The top of the bottom floor (including basement or enclosure) of the building is I _ ft. (m) I__I __1 in. (cm) _ above or _ below (check one) the highest adjacent grade. (Use natural grade, if available.) :3. For Building Diagrams 6 -8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is l_L__I ft. (m) ( 1_in. (cm) above the highest adjacent grade. Complete Items C3.h and C3.1 on front of form. :4. The top of the platform of machinery and /or equipment servicing the building is ( LJ ft. (m) I 1_1 in. (cm) I_I above or IJ below (check one) the highest adjacent grade. (Use natural grade, if available.) :5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? I 1 Yes I I No 1 I Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (items C3.h and C3.i only), and E for Zone A (without a FEMA - issued or community - issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best of my knowledge. _ PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS I._i Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) he local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete ections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. 4 i1. LJ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) i2. Li A community official completed Section E for a building located in Zone A (without a FEMA- issued or community - issued BFE) or Zone AO. i3. I I The following information (items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED GS. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED i7. This permit has been issued for: LJ New Construction 1J Substantial Improvement ;8. Elevation of as -built lowest floor (including basement) of the building is: _ ft. (m) Datum: ;9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft. (m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I I Check here if attachments EMA Form 81 -31. January 2003 Rnnlaces all crQvious �diticns